RE: Horizon BCBS of New Jersey - non reimbursement for PT eval

[Guest guest]

,

You can try and bill for some of the manual muscle testing codes which are

95833 and 95834 which should be paid for if the eval is not.

-

Physical Therapy

Delray Beach, Fl

From: PTManager [mailto:PTManager ] On Behalf

Of therapybilling

Sent: Friday, February 22, 2008 12:03 PM

To: PTManager

Subject: Horizon BCBS of New Jersey - non reimbursement for PT

eval

A company in our area (Texas) recently changed to this insurance. I

see a question on this forum from 2004 about the non-reimbursement for

evals and it seems nothing has changed!

Can anyone advise us of their practice's solution to be reimbursed for

the eval?

thanks

[Guest guest]

,

Mr. Platz is correct in the fact that Horizon BC/BS has never paid

for evaluations at least for the 35 years he has been practicing.

Unfortunately, the approach recommended to correct this problem has

failed, including meeting with the insurance company to argue the

point. I guess we should wait for another 35 years to pass before

change will occur. The only way to change the thinking of an

insurance company that has billions in reserve and fails to see the

benefit nor the statues that require us to perform an evaluation

before initiating treatment, is to force their hand. How is this

done? Legislatively!

We can no longer wait for change to occur or our profession will

suffer irreparable damage. Insurance companies are unwilling to come

to the table and negotitate. Why should they? They hold all the

cards and as we know, those that hold the cards always win.

Here in NJ, legislation has been proposed to correct the problem, not

only addressing reimbursement for evlauations but low reimbursement

rates in general. Stay tuned for the change to occur. I bet it will

be much faster than the 35 years with the current approach, which has

failed miserably.

Bertone, PT, OCS

Vice President, NJSIPT

www.njsipt.com

[Guest guest]

,

Can you summarize this legislation, describe the Chapter's strategy, and

advise the rest of us? Where does this legislation sit and will it be

acted on soon? Thanks!

Trevor Swan, PT

town, WV

Re: Horizon BCBS of New Jersey - non reimbursement

for PT eval

,

Mr. Platz is correct in the fact that Horizon BC/BS has never paid

for evaluations at least for the 35 years he has been practicing.

Unfortunately, the approach recommended to correct this problem has

failed, including meeting with the insurance company to argue the

point. I guess we should wait for another 35 years to pass before

change will occur. The only way to change the thinking of an

insurance company that has billions in reserve and fails to see the

benefit nor the statues that require us to perform an evaluation

before initiating treatment, is to force their hand. How is this

done? Legislatively!

We can no longer wait for change to occur or our profession will

suffer irreparable damage. Insurance companies are unwilling to come

to the table and negotitate. Why should they? They hold all the

cards and as we know, those that hold the cards always win.

Here in NJ, legislation has been proposed to correct the problem, not

only addressing reimbursement for evlauations but low reimbursement

rates in general. Stay tuned for the change to occur. I bet it will

be much faster than the 35 years with the current approach, which has

failed miserably.

Bertone, PT, OCS

Vice President, NJSIPT

www.njsipt.com

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[Guest guest]

Trevor,

Thank you for your interest in this solution. This was not initiated

by the State Chapter of APTA. It was initiated by the New Jersey

Society of Independent Physical Therapists (NJSIPT). You can read

more about our organization and mission at www.njsipt.com.

Basically we needed to take action as a group of independent

practitioners to make change and save our profession. We could no

longer wait for the antiquated, diversified system to institute

change. Please feel free to contact me directly with any questions.

Bertone, PT, OCS

Vice President NJSIPT

>

> ,

>

>

>

> Can you summarize this legislation, describe the Chapter's

strategy, and

> advise the rest of us? Where does this legislation sit and will it

be

> acted on soon? Thanks!

>

>

>

> Trevor Swan, PT

>

> town, WV

>

>

>

> Re: Horizon BCBS of New Jersey - non

reimbursement

> for PT eval

>

>

>

> ,

>

> Mr. Platz is correct in the fact that Horizon BC/BS has never paid

> for evaluations at least for the 35 years he has been practicing.

> Unfortunately, the approach recommended to correct this problem has

> failed, including meeting with the insurance company to argue the

> point. I guess we should wait for another 35 years to pass before

> change will occur. The only way to change the thinking of an

> insurance company that has billions in reserve and fails to see the

> benefit nor the statues that require us to perform an evaluation

> before initiating treatment, is to force their hand. How is this

> done? Legislatively!

>

> We can no longer wait for change to occur or our profession will

> suffer irreparable damage. Insurance companies are unwilling to

come

> to the table and negotitate. Why should they? They hold all the

> cards and as we know, those that hold the cards always win.

>

> Here in NJ, legislation has been proposed to correct the problem,

not

> only addressing reimbursement for evlauations but low reimbursement

> rates in general. Stay tuned for the change to occur. I bet it will

> be much faster than the 35 years with the current approach, which

has

> failed miserably.

>

> Bertone, PT, OCS

> Vice President, NJSIPT

> www.njsipt.com

>

>

>

>

>

> CONFIDENTIAL

> This message contains confidential information and is intended only

for PTManager If you are not the named addressee you

should not disseminate, distribute or copy this e-mail. Please notify

the sender immediately by e-mail if you have received this e-mail by

mistake and delete this e-mail from your system.

>

>